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Nursing Lecture Pediatrics

Nursing Lecture Pediatrics

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Published by: Aedge010 on Sep 01, 2010
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05/18/2012

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PEDIATRICS
Congenital Heart Defects
A.Congenital heart defects in general1.Etiology: usually not known - associated with maternal factors:a.infection b.alcoholismc.age over 40 yearsd.diabetes mellitus, type onee.genetics, chromosomal changes2.General findings of congenital heart defectsa.child small for age b.physiological failure to thrivec.exercise intoleranced.dyspnea while feedinge.squatting positionf.clubbing of fingers3.Physical consequences of cardiac problemsa.increased workload; pulmonary hypertension; decreased systemic output;cyanotic defects
 b.
can lead to hypoxemia and polycythemiac.concern: formation of thrombus with embolusB.Acyanotic defect - infant/child is "pink"1.Pathology: hole in the heart's internal walla.blood flows from heart's arterial (left) to venous (right) side or a "left to rightshunt", not systemically, but only within heart itself  b.size of defect will determine severity of condition2.Four common types: all with increased pulmonary blood flowC.Cyanotic defect: infant/child is "blue"1.Pathologya.unoxygenated blood mixes with oxygenated, via a "right to left shunt" b.decreases oxygenation to the entire systemc.results far more severe than acyanoticd.thrombus formation is always a concern
 
D.Nursing care of the child with a congenital heart defect1.Emotional, physiological, and psychological interventions2.Assisting the child and family to adjust to special needs3.Goals of treatmenta.child will maintain adequate oxygenation and physiological stability b.family will understand signs and symptoms of the condition, and how tomanage each of themc.child will attain milestones of normal growth and developmentd.when child has surgery, child and family will be prepared, know prognosis, andknow how to give home care afterward4.Nursing interventions
a.
recognize CHF b.monitor height, weight, vital signs, pulses, pulse oximeter, intake and outputc.give medications: digoxin (Lanoxin), furosemide (Lasix) or chlorothiazide(Diuril); monitor for desired outcomes and side effectsd.recognize and treat pain appropriately: pharmacological andnonpharmacological interventionse.maintain a safe environmentf.conserve energyg.maintain proper nutrition, with small, frequent feedingsh.support and discuss treatment with parentsi.place in proper position - slanting position with head elevated, older babies ininfant seats, occasional knee-chest
Acquired Cardiovascular Disorders
E.Hyperlipidemia: excessive lipids1.Etiology: dietary, heredity2.Pathophysiologya.increased lipids and cholesterol b.causes atherosclerosis, leading to coronary heart disease3.Diagnosis: lab tests: increased LDL, lipids and cholesterol; decreased HDL4.Managementa.diet: ADA diet in two steps:i.< 30 kcal from fat; < ten from saturated fat; < 300 mg/L cholesterolii.< 30 kcal from fat, < seven from saturated fat; < 200 mg/Lcholesterol b.medications: colestipol (Colestid), niacin (Nicor), cholestyramine (Questran)
General
 
A.
Respiratory infections (
)1.Etiology: bacterial, viral; often influenced by age, season, preexisting disorder, livingconditions2.Findings: increased respiratory and heart rate, fever, nausea/vomiting, nasal dischargeand blockage, mucus production, coughing, adventitious lung sounds3.Nursing care goals:a.child will not exhibit findings of respiratory distress, will be able to cleasecretions, and remain comfortable with a patent airway b.child will not spread infection to othersc.child will ingest adequate fluids, and maintain hydration4.Management:a.medications: antibiotics, antipyretics b.possible: anti-inflammatory, anti-mucolytics, bronchodilators, oxygen asneededc.chest physiotherapyd.nutrition and fluidsB.Respiratory failure: inability to maintain adequate oxygenation1.Predisposing factorsa.obstructive anomalies, aspiration b.infections, tumors, anaphylaxisc.restrictive conditions: respiratory distress, cystic fibrosis, pneumonia, pneumothoraxd.paralytic conditions2.Findingsa.restlessness, mood changes b.changes in LOCc.increasing rates of respiration and pulsed.dyspnea3.Management
a.
frequent observation and physical exams, with pulse oximeter   b.correct hypoxemia, maintain ventilation and deliver oxygenc.monitor for side effects and expected outcomes of therapyC.Airway obstruction and basic life support1.Cardiac arrest is usually due to prolonged hypoxemia secondary to inadequateventilation, oxygen or circulation2.When following guidelines for pediatric life support, consider not just the child's age, buthis or her size. Individual anatomy and development will vary.3.Airway clearance techniquesa.determine conscious versus unconscious child b.for infants and toddlers: back blows and chest thrustsc.for preschool and school-age: modified Heimlich maneuver ("astride")
Infant Respiratory Disorders
D.Respiratory distress syndrome ( RDS): "hyaline membrane disease"1.Etiology
a.
 premature infants: usually due tosurfactantdeficiency b.newborns: birth asphyxia, multiple gestations, diabetic mothec.older children: trauma, drowning2.Pathophysiologya.decrease in amount and/or quality of pulmonary surfactant b.in older children, surfactant may be washed out by drowning or fluid aspiration
3.
Findingsa.tachypnea, increased respiratory effort b.paradoxic "seesaw" respirationsc.nasal flaringd.substernal retractionse.expiratory grunt, possible apneaf.cyanosisg.hypoxia4.Diagnosticsa.physical exam, pulse oximete

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